The Extent of Engagement With Telehealth Approaches by Patients With Advanced Cancer: Systematic Review

Abstract

Background Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. Objective The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. Methods This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. Results Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. Conclusions Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117232

Digital health and telehealth in cancer care: a scoping review of reviews

“…The remaining 134 reviews met eligibility criteria and were included in the synthesis. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 …”

“…Three reviews addressed telehealth interventions for individuals facing advanced cancer, including those at the end of life. 17 , 23 , 73 Characterising the use and benefits of digital health and telehealth interventions for these populations is important as many patients with terminal cancer and their families prefer palliative care delivered at home versus a health-care facility. 153 Although bereavement care for families is traditionally a component of comprehensive palliative care and was included in several of the digital health and telehealth palliative care programs covered in reviews (eg, Dionne-Odom and colleagues and Pearce and colleagues), 154 , 155 none of the reviews specifically addressed family caregiver bereavement.…”

Distance Monitoring of Advanced Cancer Patients with Impaired Cardiac and Respiratory Function Assisted at Home: A Study Protocol in Italy

“…Moreover, the constant and continuous monitoring of vital parameters at every stage of the disease or whenever required could reduce suffering and anxiety, improving QOL. However, in this field, it is difficult to have a clear vision [7], whereas many tools could be included within telehealth and information technology (e.g., mobile phone devices, internet-based interventions, interactive health communication applications, virtual programs of support, and symptom monitoring tools) [8]. Specifically, our feasibility study may help to figure out if this telemonitoring tool is useful for advanced cancer patients assisted at home in order to increase the knowledge about the more appropriate telehealth intervention for this specific group of patients.…”

“…We expect a significant level of engagement in terms of the number of selfmeasurements/week per patient, ease of use, difficulties experienced, and usefulness. In this feasibility study, engagement will be evaluated by some indicators as defined by Perski et al, 2017 (and echoed by Goodman et al, 2022), including the frequency and duration of measurements, depth of device use, and others [8,42].…”

“…However, the level of user satisfaction and engagement with these interventions remains unclear for advanced cancer patients. Recent research suggested that patient engagement can be considered a key factor in the effectiveness evaluation and a primary criterion in feasibility studies of telehealth approaches [8]. Therefore, there is a need to further investigate how advanced cancer patients engage with the wide range of existing telehealth devices to offer patientcentered care with a telemonitoring intervention personalized based on patients' needs and clinical condition Furthermore, scientific evidence is progressively underlining the potential role of telemedicine in home care protocols to assist an increasing number of advanced cancer patients with an efficient program of early palliative care [9,10].…”